tbuckley/cabot-search huggingface dataset:
High-Dose Therapy and Autologous Stem-Cell Transplantation Versus Conventional Therapy for Patients With Advanced Hodgkin’s Lymphoma Responding to Front-Line Therapy
Authors: Massimo Federico, Monica Bellei, Pauline Brice, Maura Brugiatelli, Arnon Nagler, Christian Gisselbrecht, Luciano Moretti, Philippe Colombat, Stefano Luminari, Francesco Fabbiano, Nicola Di Renzo, Anthony Goldstone, Angelo Michele Carella
Journal: Journal of Clinical Oncology (2003)

Purpose: To determine whether high-dose therapy (HDT) with autologous stem-cell transplantation (ASCT) should be included in the initial consolidative treatment of patients with advanced, unfavorable Hodgkin’s lymphoma (HL). Patients and Methods: One hundred sixty-three patients achieving complete remission (CR) or partial remission (PR) with four initial courses of doxorubicin, bleomycin, vinblastine, and dacarbazine, or other doxorubicin-containing regimens, were randomly assigned to receive HDT plus ASCT (83 patients) versus four courses of conventional chemotherapy (80 patients). Unfavorable HL was defined as the presence of at least two of the following poor prognostic factors: high lactate dehydrogenase level, large mediastinal mass (greater than at least 33% of the thoracic diameter), more than one extranodal site, low hematocrit level, and inguinal involvement. Results: At the end of the treatment program, 92% of patients in arm A and 89% in arm B achieved a CR (P = .6). After a median follow-up of 48 months, the 5-year failure-free survival rates were 75% (95% confidence interval [CI], 65 to 85) in arm A and 82% (95% CI, 73 to 90) in arm B (P = .4). The 5-year overall survival rates were 88% (95% CI, 80 to 96) in arm A and 88% (95% CI, 79 to 96) in arm B (P = .99). The 5-year relapse-free survival rates were 88% in arm A (95% CI, 80 to 96) and 94% in arm B (95% CI, 88 to 100), and the difference was not significant (P = .3). Conclusion: Patients with advanced unfavorable HL achieving CR or PR after four courses of doxorubicin-containing regimens have a favorable outcome with conventional chemotherapy. No benefit from an early intensification with HDT and ASCT was shown.
Splinter Hemorrhages at High Altitude
Authors: Drummond Rennie
Journal: JAMA (1974)

<h3>To the Editor.—</h3> On the recent American Expedition to Dhaulagiri, Nepal, (8,167 meters [26,795 feet]), the sixth highest mountain in the world, I developed numerous splinter hemorrhages in my fingernails. They appeared spontaneously during a restful evening when I was at base camp (5,880 meters [19,300 feet]), and the next morning I counted 46, of which 11 were beneath each thumbnail. The hemorrhages were thin, red, longitudinal streaks between 0.5 and 4 mm long, arranged near the distal part of the nail bed in a corona (Fig 1). As they grew out, they could be seen to lie in the soft, thin layer peeling off the undersurface of the nail. I had spent the previous five weeks in good health, transporting loads of 18 to 27 kg (40 to 60 lbs) from 760 meters (2,500 feet) to base camp, where I had been living for six days. The previous day
Screening for Depression: Recommendations and Rationale
Journal: Annals of Internal Medicine (2002)

This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendations for screening for depression and the supporting scientific evidence and updates the 1996 USPSTF recommendations on this topic. At that time, the USPSTF concluded that there was insufficient evidence to recommend for or against routine use of standardized questionnaires to screen for depression in primary care patients. The complete information on which the current statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the systematic evidence review on this topic, which can be obtained through the USPSTF Web site (www.ahrq.gov/clinic/uspstfix.htm) and in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (800-358-9295). *For a list of the members of the U.S. Preventive Services Task Force, see the Appendix.
Numerators Without Denominators
Authors: David H. Spodick
Journal: JAMA (1975)

EACH day, physicians face complex decisions in choosing accurate diagnoses and optimum treatments. We have become quite adept at marshaling objective data for diagnostic choices. Therapeutic decisions must often depend on less substantial evidence. In consequence, elaborate methods are required for clinical trials to test the effectiveness and safety of new drugs, but, somehow, the same type of rigorous criteria are not demanded for trials of new operations. Much thought and huge sums of money have been directed toward ensuring the outcome when the physician writes a prescription, but there is not this type of concern generated when he flourishes a scalpel. If this division of requirements were really proportionate, it might be justified as a backhanded acknowledgment that the pen is indeed mightier than the sword. Unfortunately, this is nottrue; there is no evidence that we need less demanding criteria for making surgical than medical choices. <h3>Comparing Treatments: The</h3>
The Relative Risk of Incident Coronary Heart Disease Associated With Recently Stopping the Use of β-Blockers
Authors: Bruce M. Psaty
Journal: JAMA (1990)

We conducted a population-based, case-control study of risk factors for first events of coronary heart disease in patients with high blood pressure. All subjects had hypertension treated with medication. The 248 cases presented with new coronary heart disease from 1982 through 1984, and the 737 controls were a probability sample of health maintenance organization patients free of coronary heart disease. The health maintenance organization's computerized pharmacy database identified recent stoppers—patients who did not fill their prescriptions regularly enough to be at least 80% compliant. After adjustment for potential confounding factors, subjects who had recently stopped using β-blockers had a transient fourfold increase in the relative risk of coronary heart disease (relative risk, 4.5; 95% confidence interval, 1.1 to 18.5). The association was specific to β-blockers but not diuretics. A withdrawal syndrome immediately following the cessation of β-blocker use may be an acute precipitant of angina and myocardial infarction in hypertensive patients who have no prior history of coronary heart disease. (<i>JAMA</i>. 1990;263:1653-1657)
Oregon's Methods
Authors: David M. Eddy
Journal: JAMA (1991)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction
Authors: Thomas J Ryan, Elliott M Antman, Neil H Brooks, Robert M Califf, L.David Hillis, Loren F Hiratzka, Elliot Rapaport, Barbara Riegel, Richard O Russell, Earl E Smith, W.Douglas Weaver, Raymond J Gibbons, Joseph S Alpert, Kim A Eagle, Timothy J Gardner, Arthur Garson, Gabriel Gregoratos, Richard O Russell, Thomas J Ryan, Sidney C Smith
Journal: Journal of the American College of Cardiology (1999)
Diagnostic Value of Sinus-tract Cultures in Chronic Osteomyelitis
Authors: Philip A. Mackowiak, Stephen R. Jones, James W. Smith
Journal: JAMA (1978)

Sinus-tract cultures were compared with cultures of operative specimens from 40 patients with chronic osteomyelitis. Thirty-five patients (87.5%) had a single pathogen isolated from their operative specimens. Only 44% of the sinus-tract cultures contained the operative pathogen. Isolation of<i>Staphyloccus aureus</i>from sinus tracts correlated with the presence of<i>S aureus</i>in the operative specimen. However, less than half of the sinus-tract cultures obtained from patients with<i>S aureus</i>osteomyelitis contained this organism. Isolation of bacteria other than<i>S aureus</i>from sinus tracts had a low likelihood of predicting the pathogen isolated from bone. A presumptive diagnosis of<i>S aureus</i>osteomyelitis is justified if<i>S aureus</i>is isolated from an associated sinus tract. A bacteriologic diagnosis of chronic osteomyelitis based on isolation of common pathogens other than<i>S aureus</i>from sinus tracts must be verified by an appropriate operative culture. (<i>JAMA</i>239:2772-2775, 1978)
Management of Life-Threatening Acid–Base Disorders
Authors: Horacio J. Adrogué, Nicolaos E. Madias
Journal: New England Journal of Medicine (1998)

Acid–base homeostasis exerts a major influence on protein function, thereby critically affecting tissue and organ performance. Deviations of systemic acidity in either direction can have adverse consequences and, when severe, can be life-threatening. Yet it is the nature of the condition responsible for severe acidemia or alkalemia that largely determines the patient's status and prognosis. Whereas a blood pH of 7.10 can be of little consequence when caused by a transient or easily reversible condition, such as an isolated seizure, it forecasts an ominous outcome if it is the result of methanol intoxication. Similarly, a blood pH of 7.60 seldom . . .
Staging of Disease
Authors: Joseph S. Gonnella
Journal: JAMA (1984)

Measurement of illness severity is required to evaluate diagnostic efficiency of physicians, assess quality of care, understand utilization of health services, design clinical trials, and reimburse hospitals on the basis of output. "Staging" is a method for measuring severity of specific, well-defined diseases. Staging defines discrete points in the course of individual diseases that are clinically detectable, reflect severity in terms of risk of death or residual impairment, and possess clinical significance for prognosis and choice of therapeutic modality. Medical staging criteria have been developed for 420 diagnoses and converted into "coded" criteria for the major diagnostic coding systems. Coded criteria can be efficiently applied to computerized hospital discharge abstracts to derive a comprehensive case-mix classification system. Uses of staging in epidemiologic, case-mix, and utilization analyses are illustrated for diabetes mellitus. (<i>JAMA</i>1984;251:637-644)
Clinically Recognized Dysplastic Nevi
Authors: Margaret A. Tucker
Journal: JAMA (1997)

<h3>Objective.</h3> —To investigate the relationship of number and type of nevi to the development of melanoma. <h3>Design.</h3> —Case-control study. <h3>Setting.</h3> —Outpatient clinics in referral hospitals. <h3>Patients.</h3> —Cases were 716 consecutive patients with newly diagnosed melanoma identified at 2 melanoma centers between January 1,1991, and December 31, 1992. Stratified random sampling of patients from outpatient clinics was used to identify 1014 participating controls of the same age, sex, race, and geographic distribution as the melanoma cases. All study subjects underwent an interview, a complete skin examination, photography of the most atypical nevi, and, if the patient was willing, a biopsy of the most atypical nevus. <h3>Main Outcome Measures.</h3> —Number and type of nevi on the entire body were systematically reported. All diagnoses of clinically dysplastic nevi were confirmed by expert examiners. <h3>Results.</h3> —Risk for melanoma was strongly related to number of small nevi, large nondysplastic nevi, and clinically dysplastic nevi. In the absence of dysplastic nevi, increased numbers of small nevi were associated with an approximately 2-fold risk, and increased numbers of both small and large nondysplastic nevi were associated with a 4-fold risk. One clinically dysplastic nevus was associated with a 2-fold risk (95% confidence interval, 1.4-3.6), while 10 or more conferred a 12-fold increased risk (95% confidence interval, 4.4-31). Congenital nevi were not associated with increased risk of melanoma. <h3>Conclusions.</h3> —Although nondysplastic nevi confer a small risk, clinically dysplastic nevi confer substantial risk for melanoma. On the basis of nevus number and type, clinicians can identify a population at high risk of this epidemic cancer for screening and intervention.
Intracranial Aneurysms
Authors: Alfred Uihlein, Collin S. MacCarty, Hendrik J. Svien, John D. Michenfelder
Journal: JAMA (1963)

THE ADVANTAGES of neurosurgical intracranial exposure in an avascular field are obvious. To accomplish this objective, experimental and clinical studies have been made to obtain an avascular surgical field by combining deep hypothermia and total circulatory arrest with the aid of an extracorporeal mechanical circuit and "total heparinization" of the blood. Temporary occlusion of the afferent blood supply prior to clipping of a cerebral aneurysm under moderate hypothermia of 25 to 30 C (77 to 86 F) by cooling of the body surface has been carried out successfully. Yet prolonged occlusion at these temperatures may be attended with serious neurologic sequelae, whether arrest of the arterial blood flow to the brain has been accomplished by simultaneous occlusion of the carotid and vertebral arteries in the neck<sup>1</sup>or by application of temporarily placed clips on the circle of Willis.<sup>2</sup>At these temperatures the dangers of ventricular fibrillation are a
Thyroid Hormone Use and Bone Mineral Density in Elderly Women
Authors: Diane L. Schneider
Journal: JAMA (1994)

<h3>Objective.</h3> —To determine the effect of long-term use of thyroid hormone on bone mineral density (BMD) in elderly women and the potential mitigating effects of estrogen replacement therapy. <h3>Design.</h3> —Cross-sectional, community-based study. <h3>Setting.</h3> —Rancho Bernardo, Calif. <h3>Participants.</h3> —A total of 991 white women aged 50 to 98 years who participated in a study of osteoporosis. <h3>Main Outcome Measures.</h3> —Bone mineral density at the ultradistal radius and midshaft radius using single-photon absorptiometry and at the hip and lumbar spine using dual-energy x-ray absorptiometry. <h3>Results.</h3> —A total of 196 women taking thyroid hormone for a mean duration of 20.4 years were compared with 795 women who were not using thyroid hormone. Women taking daily thyroxine-equivalent doses of 200 μg or more had significantly lower BMD levels at the midshaft radius and hip compared with those taking less than 200 μg. Daily doses of 1.6 μg/kg and greater were associated with lower bone mass at all four sites compared with nonuse, whereas doses less than 1.6 μg/kg were not associated with lower BMD levels. These associations were independent of age, body mass index, smoking status, and use of thiazides, corticosteroids, and estrogen. Women taking both estrogen and a thyroid hormone dose of 1.6 μg/kg or greater had significantly higher BMD levels at all four sites than women taking the same thyroid hormone dose alone. Women taking both thyroid hormone and estrogen had BMD levels comparable with those observed in women taking only estrogen. <h3>Conclusions.</h3> —Long-term thyroid hormone use at thyroxine-equivalent doses of 1.6 μg/kg or greater was associated with significant osteopenia at the ultradistal radius, midshaft radius, hip, and lumbar spine. Estrogen use appears to negate thyroid hormone—associated loss of bone density in postmenopausal women. (<i>JAMA</i>. 1994;271:1245-1249)
Standards for analysis of ventricular late potentials using high-resolution or signal-averaged electrocardiography: A statement by a task force committee of the European Society of Cardiology, the American Heart Association, and the American College of Cardiology
Authors: Günter Breithardt, Michael E. Cain, Nabil El-Sherif, Nancy C. Flowers, Vinzenz Hombach, Michiel Janse, Michael B. Simson, Gerhard Steinbeck
Journal: Journal of the American College of Cardiology (1991)
Reply
Authors: Jozef Bartunek, Atta Behfar, Dariouch Dolatabadi, Marc Vanderheyden, Miodrag Ostojic, Jo Dens, Badih El Nakadi, Marko Banovic, Branko Beleslin, Mathias Vrolix, Victor Legrand, Christian Vrints, Jean Louis Vanoverschelde, Ruben Crespo-Diaz, Christian Homsy, Michal Tendera, Scott Waldman, William Wijns, Andre Terzic
Journal: Journal of the American College of Cardiology (2013)
Complications of Intravenous Phenytoin for Acute Treatment of Seizures
Authors: Michael P. Earnest
Journal: JAMA (1983)

Intravenous (IV) phenytoin sodium in small volumes of normal saline was administered in a municipal hospital emergency department for treatment of convulsions in 200 patients. A total of 72 complications developed in 51 patients. Twenty-nine complications were burning pain at the IV site, and 36 were related to excessive total dose of phenytoin and resultant drug intoxication. Seven other patients had cardiovascular complications, including hypotension and arrhythmias. These seven complications were related to high concentrations of drug administered at a rapid rate. Both the IV and cardiovascular complications promptly resolved when the IV rate was slowed or temporarily stopped. No patient died, and none was hospitalized because of a complication. The authors propose specific guidelines for the safe administration of IV phenytoin. (<i>JAMA</i>1983;249:762-765)
FACTORS AFFECTING THE GROWTH OF TUBERCLE BACILLI IN LIQUID MEDIA
Authors: René J. Dubos, Bernard D. Davis
Journal: The Journal of Experimental Medicine (1946)

1. Certain water-soluble esters of long chain fatty acids (in particular of oleic acid) favor submerged and diffuse growth of mycobacteria throughout the depth of synthetic liquid media. 2. Esters of oleic acid increase considerably the amount of growth yielded by avian strains in synthetic media. 3. The addition of serum albumin to synthetic liquid media permits visible growth of minimal inocula of virulent human tubercle bacilli (10–8 mg.) within 11 to 15 days. 4. Cultures growing diffusely in media containing the water-soluble esters— with or without albumin—consist of cells of classical morphology and staining properties, which again exhibit the usual mode of growth when returned to the standard synthetic or egg yolk media.
Human Granulocytic Ehrlichiosis in the Upper Midwest United States
Authors: Johan S. Bakken
Journal: JAMA (1994)

<h3>Objective.</h3> —To characterize the clinical presentation and course, laboratory findings, and treatment outcome of 12 patients with human granulocytic ehrlichiosis. <h3>Setting.</h3> —The 12 patients were male, ranged in age from 29 to 91 years, and contracted their illness in Wisconsin or Minnesota. <h3>Methods.</h3> —Cases were recognized by the presence of intracytoplasmic inclusions (morulae) in peripheral neutrophils of patients presenting with temperature of 38.5°C or higher, chills, severe headache, and myalgias. All patients had a complete blood cell count and blood chemistry profile. Blood smears were examined by light microscopy. All available paired serum samples were analyzed for presence of indirect fluorescent antibodies against<i>Ehrlichia chaffeensis, Ehrlichia phagocytophila</i>, and<i>Ehrlichia equi</i>. Blood samples from 12 patients were subjected to polymerase chain reaction analysis using primers specific for the<i>E phagocytophila/E equi</i>group, primers that include the agent identified in our patients, as well as<i>E chaffeensis</i>. <h3>Results.</h3> —Varying combinations of leukopenia, anemia, and thrombocytopenia were found in all but one patient. All 12 patients demonstrated morulae in the cytoplasm of neutrophils, but not in mononuclear white blood cells. Serum assays failed to detect antibodies against<i>E chaffeensis</i>, but eight of 10 patients and seven of 10 patients tested had antibody titers of 1:80 or more for<i>E phagocytophila</i>and<i>E equi</i>, respectively. Polymerase chain reaction products obtained with primers for<i>E phagocytophila, E equi</i>, and the granulocytotropic<i>Ehrlichia</i>revealed that seven patients were infected with the same agent. The results of serological assays or polymerase chain reaction strongly suggest that all 12 patients were infected by<i>E phagocytophila, E equi</i>, or a closely related<i>Ehrlichia</i>species. Two of the 12 patients died. The other 10 patients improved rapidly with oral doxycycline treatment. <h3>Conclusions.</h3> —We believe that all 12 patients have been infected with a granulocytic<i>Ehrlichia</i>species, reflecting a recently described new disease entity. The infective organism appears to be closely related to<i>E phagocytophila</i>and<i>E equi</i>. The geographic domain of human granulocytic ehrlichiosis is currently unknown. This novel granulocytic<i>Ehrlichia</i>species is capable of causing fatal infections in humans. Early detection and treatment with tetracycline drugs appear to offer the best chance for complete recovery. (<i>JAMA</i>. 1994;272:212-218)
Research and Stored Tissues
Authors: Bartha Maria Knoppers
Journal: JAMA (1995)

While the debate surrounding the status of human organs, gametes, embryos, tissues, blood, and cells (property? person? gift? waste?) continues, the issues surrounding the storage and possible current and future uses of such "materials" need to be addressed. The comprehensive and sensitive articles—"Informed Consent for Genetic Research on Stored Tissue Samples" by Clayton et al<sup>1</sup>and "Ethical Aspects of Banking Placental Blood for Bone Marrow Transplantation" by Sugarman et al<sup>2</sup>—epitomize the complexity of the underlying ethical, legal, and social problems. Donors, patients, and research participants everywhere have become "sources."<sup>1</sup>Hence, the need for discussion and clarification. See also pp 1783 and 1786. Even though the article by Sugarman et al<sup>2</sup>seemingly focuses on a narrower topic, the ethical issues raised—ownership, informed consent, privacy, confidentiality, and access— are common to both genetic research and placental blood banking. Moreover, in the screening of placental blood for donation,
Increased Antidepressant Use in Patients Prescribed β-Blockers
Authors: Jerry Avorn
Journal: JAMA (1986)

Little information exists on the epidemiology of central nervous system side effects in patients taking antihypertensive medications. We examined prevalence rates of tricyclic antidepressant (TCA) use among a random sample (N=143,253) of Medicaid recipients. The TCA use was compared for patients taking any of seven antihypertensive agents and for those prescribed insulin or oral hypoglycemic agents. Use of TCA was significantly higher in patients taking β-blockers (23% over two years) than for patients taking hydralazine or hypoglycemics (both 15%) or methyldopa or reserpine (both 10%). Prevalence rate ratios revealed a risk of being prescribed a TCA of 1.5 (95% confidence interval, 1.4 to 1.7) for patients receiving β-blockers relative to patients receiving hydralazine or hypoglycemics. β-Blocker use may be an important cause of iatrogenic depression among hypertensive patients. (<i>JAMA</i>1986;255:357-360)